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Guidelines and Standards

Find operating guidelines for hospitals, clinical practices and preventive health in this section, as well as standards for HIPAA transactions and medical records, and medication policy information.

In This Section

Medication Policy List

Find policies and announcements about medications, treatments and other topics related to our medication policy.

HIPAA Transaction Standard Guide

Read an explanation of HIPAA, including Blue Shield's commitment to protecting the privacy of patient medical records.

Provider Claims and Dispute Resolution Regulations

Review the AB1455 regulations approved by the Department of Managed Healthcare, Blue Shield's regulations summary and a compliance overview.

Medical Record Standards

Access Blue Shield's policy on medical record standards, and generic forms to assist providers with documentation requirements.

Blue Shield and Utilization Management Decisions

How Blue Shield makes utilization management decisions.

Preventive Health Guidelines

Access preventive health guidelines for healthy children, adolescents and adults. Included are immunizations, health screenings and more.

Clinical Practice Guidelines

Blue Shield recommendations for evaluating common acute and chronic conditions such as asthma, diabetes and depression.

Protecting the Confidentiality of Personal and Health Information

Blue Shield's policy for sharing and disclosing private member data.

Continue Participation in Our Network

How providers continue participation in the Blue Shield network, including a recredentialing application and mailing instructions.

National Provider Identifier FAQ

Frequently asked questions about the National Provider Identifier, the unique number assigned to all healthcare providers to facilitate transactions.

Hospitals/Facilities

Resources on hospital and facility guidelines, updates and announcements.

Other Payor Summary List

View a list of Other Payors (employers, insurance companies, associations, etc.) with which Blue Shield holds contracts.